President Donald Trump has revealed at a press conference he is taking hydroxychloroquine and azithromycin to ward off the threat of Covid-19. The revelation comes despite studies showing no benefits from the drug combination, and strong evidence it can cause heart attacks.
The president, who discussed the treatment with his physician, can make his own medical choices, but inevitably his statement will encourage many people to follow his example. That is particularly dangerous if this occurs without a doctor to advise on dosage and track symptoms.
The admission was made while responding to claims he fired director of the Advanced Research and Development Authority Rick Bright for not promoting the drug. “What do you have to lose? I've been taking it for about a week and a half,” Trump said at the roundtable event at the White House Monday, suggesting he started around the time Vice President Pence's press secretary, who is married to one of Trump's senior advisers, tested positive. “I take it because I hear very good things.”
Around the world, hundreds of trials are being undertaken for possible treatments for Covid-19 and protections against the SARS-CoV-2 virus that causes it. Most of these are being run in a normal scientific manner; everyone hopes they will work but they are prepared to wait and see about the outcome.
Trump has turned the anti-malarial drug hydroxychloroquine, particularly in combination with the antibiotic azithromycin, into the exception. He has touted its supposed benefits more than 50 times on Twitter and in press conferences since March. Consequences have included inspiring research that breaches basic ethical guidelines and shortages of the product making it unavailable for those who need it for other conditions. An Australian billionaire has bought 33 million doses and spent millions on adverts boasting of his contribution to keeping the country safe, despite medical reluctance to prescribe it.
In the light of his revelation, at least Trump can't be accused of hypocrisy now he has reported taking it himself. He is apparently a true believer, rather than simply promoting the drug in the hope it will soothe fears about the disease, as some initially suspected. However, at this stage we don't know if the hydroxychloroquine/azithromycin combination has any protective or preventative effect for those who have not yet caught the virus, as it has only been tested as a treatment on confirmed cases.
Trials of people with serious symptoms have not been favorable – the initial study that inspired Trump's enthusiasm was small and badly conducted. Larger trials have produced unfavorable results, with some being canceled early because it would be unethical to continue. The US Food and Drug Administration (FDA) currently cautions against taking hydroxychloroquine or chloroquine outside of a hospital or clinical trial setting due to the risk of heart rhythm problems. The Centers for Disease Control and Preventions (CDC) removed its advice and guidelines for doctors on how to prescribe the anti-malaria drug back in April, replacing it with: "There are no drugs or other therapeutics presently approved by the U.S. Food and Drug Administration (FDA) to prevent or treat COVID-19."
Trump said the only evidence he had seen it doesn't work came from people who “weren't big Trump fans”.
It is true, however, certain drugs can protect against specific pathogens taking hold, while having no benefit later on. Studies of healthy people who may be exposed to the virus in the future require much larger sample sizes than those that test the already sick, so we don't yet have a lot to go on in regard to hydroxychloroquine for protective purposes.
Consequently, Trump's approach may eventually be vindicated. However, the failure of the drug to treat the already sick, and the associated side-effects, have aroused deep skepticism among doctors, particularly regarding use outside hospital environments.
Surprisingly, touting a drug that has so far defied evidence of any benefits isn't the worst approach people are trying to beat Covid-19. A pastor in Cameroon who laid hands on hundreds of parishioners claiming he could cure them of the virus died a week later.